Substance misuse

Buvidal is the only licensed UK version of long-acting injectable buprenorphine (LAIB). Introduced in 2019, it was rolled out widely in Wales during the pandemic.

The benefits, beyond allowing people to manage on a monthly, pandemic-saving dose, were quickly apparent. It reduced craving and anxiety, reduced drug-related deaths, was strongly associated with the reduction in hospital drug-related admissions and allowed patients to return to their families and their lives, including successfully detoxifying.

It is now the most prescribed Opiate Substitution Treatment in Wales (nearly 50%) and further roll-out in primary care, secondary care, hospital liaison, prisons and the third sector could bring further benefits, with the benefits fitting with the aims of the WG priorities for Mental Health. 

A hub and spoke national delivery of the complementary psychological support service (BPSS). While Buvidal treats opiate dependence effectively, 50% of users experience resurfacing trauma symptoms, impacting wellbeing, increasing risk of relapse, and limiting long-term recovery.

In March 2023, Cardiff and Vale APB funded a 2-year pilot to deliver a rapid-access, tiered psychological service – the BPSS – for individuals on Buvidal, supporting them through all stages of treatment. The BPSS aim was to create a scalable, stepped-care model that addressed psychological barriers to recovery and improved quality of life. Because patients treated with Buvidal were, clinically, in a significantly better position to engage with treatment, the outcomes were significant, showing statistically significant improvements in psychological wellbeing, functioning, and reduced hospital admissions, reinforcing the need for psychological support as a core element of Buvidal treatment. Cost-effectiveness was also shown (less than £6,000 per Quality Adjusted Life Year [QALY]).

The vision would be to ensure that across Wales, all people on Buvidal will have access to flexible, tiered, trauma-informed psychological support.

The Welsh Government Treatment Framework for ARBD (2021) recognised the impact on health and social care provisions of a lack of specialist services (e.g., prolonged lengths of stay, long-term residential care). Among its recommendations, it advocated the establishment of dedicated ARBD community services in each Health Board alongside regional inpatient centres of excellence to support appropriate diagnostic assessment, research and evaluation on clinical and service delivery models.

ARBD is a neurocognitive disorder that can be arrested and potentially reversed with early interventions. As a result of the cognitive difficulties, approaches to assessment, diagnosis and intervention, need to be adapted and delivered by appropriately trained clinicians.

The establishment of two regional centres for Wales (one North and one South) providing:

• Specialist inpatient beds for individuals with ARBD (or likely ARBD) who require further assessment (clinical and functional) to inform placement and care planning
• A hub for clinical research (developing evidence-based diagnostic procedures and clinical interventions)
• A hub of expertise supporting the development of community ARBD services in each health board area

Those with co-occurring needs often fall between services and, as a result, have increased morbidity and mortality associated with this poor access to appropriate treatment. There is also increased health and social cost due to higher rates of hospital admissions (both mental health and physical health as well as longer-term placement costs for example there are high rates of co-occurring conditions within mental health rehabilitation settings), higher rates of homelessness/problems with housing and a higher level of criminal justice interventions.

Whilst the Co-occurring Framework does not indicate historical dual diagnosis roles are of benefit in terms of encouraging the implementation of the Co-occurring Framework, there has been some indication that repurposing the co-occurring practitioner role with clear direction for that worker can be successful. 

The practitioner can then focus upon leading and supporting the implementation of the principles of the Co-occurring Framework from within mental health services as the lead service. This includes providing support and education for staff from both Mental Health and Drug and Alcohol services, facilitating and supporting joint working, reducing stigma and improving joined up care for service users, allowing them to have a clear understanding of their care and how their needs will be best supported.